Résumé
@#Gestational trophoblastic neoplasia (GTN) in itself is an uncommon condition, much so is primary extrauterine GTN. The incidence of GTN in the Philippines is at 22.4/40,000 pregnancies. However, no report has been made for primary extrauterine GTN. Only two cases of primary vaginal choriocarcinoma are reported in literature. This is a case of a 26 year old G1P0 (0010) who came in for profuse vaginal bleeding. Serum beta‑human chorionic gonadotropin (β‑hCG) was elevated and ultrasound showed hypervascular vaginal mass and an empty uterus. A primary vaginal GTN was considered and the patient was treated with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMACO) regimen. During the course of chemotherapy, there was a note of profuse vaginal bleeding which was controlled by angiographic uterine artery embolization. A normal β‑hCG level was achieved after six cycles of EMACO. The patient was able to have three successful pregnancy outcomes thereafter. Primary vaginal GTN is a rare condition that requires a high index of suspicion. In a nulliparous patient complicated with profuse vaginal bleeding, angiographic embolization is an effective fertility‑sparing procedure that can manage the said complication.
Sujets)
Tumeurs trophoblastiques , Embolisation thérapeutique , Grossesse extra-utérineRésumé
Pyometra, an accumulation of pus within the uterine cavity, is a rare gynecologic disease with an incidence of 0.01-0.5% among all gynecologic patients and 13.6% among elderly gynecologic patients. Pyometra in itself is rare, much so is uterine rupture occurring secondary to it. No local data reporting incidence of ruptured pyometra in the Philippines has been published. This is a case of a 63-year-old Gravida 5 Para 5 (5-0-0-4), with Cervical Endometrioid Adenocarcinoma Stage IIIB, presented with abdominal pain. Whole abdominal Computed Tomography scan revealed pneumoperitoneum. Initial assessment was pneumoperitoneum probably secondary to ruptured viscus. The patient underwent exploratory laparotomy which revealed ruptured pyometra. Subsequent management included drainage, culture guided antibiotics, radiotherapy and brachytherapy. Spontaneous rupture of pyometra is a serious medical condition which requires an accurate diagnosis in order to arrive in appropriate surgical and medical management. However, pre-operative diagnosis is difficult despite the presence of advanced imaging techniques, hence high level of suspicion is warranted in identifying this condition.
Sujets)
Humains , Femelle , Adulte d'âge moyen , Rupture utérine , Pyométrie , Pneumopéritoine , Curiethérapie , Carcinome endométrioïde , Injections péritoneales , Douleur abdominaleRésumé
Metastasis of malignancy to the uterine cervix is a rare event in itself. Breast cancer is a commonly diagnosed malignancy in women that has been extensively studied, and it has been known that common areas of metastasis are the lungs, skin, liver and brain. Since the 1980's, there have been a handful of reported cases of metastasis to the uterine cervix. We present the case of a 64-year-old Gravida 4 Para 1 (1031) who developed postmenopausal bleeding 9 years after treatment of the primary breast cancer, which after work-ups, turns out to be an isolated metastatic lesion to the cervix. In cases such as this one, surgery is reasonable treatment option that is sufficient in itself without the need for chemotherapy or radiation. Our patient was offered a different treatment option, which is chemotherapy, instead of proceeding straight to the treatment option presented by most case reports, which is surgery. This paper aims to highlight a possible route of metastasis, to emphasize the need for regular gynecological examination in patients with breast cancer, as well as the importance of aggressive treatment in the form of surgery in cases of isolated cervical metastasis.